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General NPI Number Information
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NPI Number | 1215145859
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Entity Type | Individual
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Provider Name | THOMAS D PARKER PTA
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 E STANLEY BLVD STE. 112
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City | LIVERMORE
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State | CA
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Zip | 94550-4115
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Country | US
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Telephone | 925-243-1385
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Fax | 925-243-0127
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Provider Business Mailing Address
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Address Line | 65 MARY CT
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City | TRACY
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State | CA
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Zip | 95376-1337
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Country | US
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Telephone | 209-833-3438
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Fax | 209-833-3438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT 1396
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License Number State | CA
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